Patient Communications

Medical Necessity Screening

“Medically Unnecessary Service or Setting is the top error discovered in RAC audits.”

– CMS RAC Demonstration Evaluation Report

Conifer lets you determine the right level of care every time, helping you avoid overuse of Inpatient and Observation and reducing case management challenges.

For hospitals challenged by a lack of case management on admissions decisions, Conifer’s Medical Necessity Screening team can work with your Emergency Department to apply evidence-based criteria 24/7. Our clinical professionals serve as an on-call resource for your local case managers. We help determine the appropriate level of care for each admission, allowing your staff to focus on the patient.

Both Severity of Illness and Intensity of Service are reviewed to establish medical necessity. Cases that fail criteria are clearly identified for additional review according to your established protocols. Conifer’s reviews are subject to our own Quality Assurance Program.

Among the benefits of Medical Necessity Screening:

• Expert guidance before admission decisions are made
• More effective use of Inpatient or Observation
• Reduced expense of staffing overnight and weekend case management
• At-a-glance daily reporting